- Patricia Wilbarger Brushing Protocol
- Patricia Wilbarger Brushing Programming
- Patricia Wilbarger Brushing Program
Dear Melissa,
My 4-year-old son is having frequent tantrums at preschool. I was browsing a sensory processing parent support group webpage when I saw several parents discussing “brushing” and how it helps with calming their children. What exactly is it, and would it be appropriate for my child?
- Brushing Program or Therapressure Protocol Premiere among the effective interventions is the Therapressure Protocol, more popularly referred to as the brushing program. Developed by Patricia Wilbarger, M.Ed., OTR, FAOTA, the Therapressure Protocol is a specific, professionally guided treatment regime that is usually implemented by parents.
- The technique was developed for sensory defensiveness. The creator of the technique, Patricia Wilbarger, MEd, OTR, FAOTA, is a leading expert on sensory defensiveness. (This is basically when the nervous system over-reacts to stimuli that would not typically be perceived as negative or harmful.).
- The Wilbarger Deep Pressure Protocol is a very specific protocol, which entails more than simple brushing of the skin. Additionally, it is never practiced in isolation of other occupational therapies for sensory integration.
- What Is The Wilbarger Brushing Protocol? The Wilbarger Deep Pressure and Proprioceptive Technique was developed by Patricia Wilbarger, Med, OTR, FAOTA. Based on the theory of Sensory Integration, the brushing technique uses a specific method of stimulation to help the brain organize sensory information.
The Special Needs Therapressure Brush is a sensory brush designed by Patricia Wilbarger, MED, and the famous developer of brushing therapy. This oval shaped brush is easier to use than regular sensory brushes, thanks to its attached handle and ergonomic design that fits comfortably into the hand.
Ahhh…The illusive “brushing” technique. I think I was asked this question in half a dozen different ways over the past month. It seems as if every parent with a child with sensory processing disorder has heard of this technique, but no one is really sure what it is. In addition, many preschool teachers are mentioning it to parents as well. Even after 9 years as an OT, I was not really sure of the true protocol. I tried researching “brushing” in the literature, asking colleagues, browsing then internet, even YouTube, but found few answers. As a last-ditch effort, I searched the term on Wikipedia and found an article riddled with red flags stating that the information provided still needed to be verified. No wonder everyone is confused by “brushing”!
Getting to the Source
I try my very best to be a research-based occupational therapist. I try to focus on those techniques that have been proven both safe and effective. I knew that “brushing” was a technique created by Patricia Wilbarger, M.Ed, OTR, FAOTA. She has been a leader in the field of occupational therapy for decades and presents training courses along with her daughter Julia Wilbarger PhD, OTR, who is a leader in the field in her own right. So when another OT TEAM member (Katie Gehrki) and I found a 2-day course taught by the Wilbargers themselves, we jumped at the chance to receive training directly from the source.
The Wilbargers’ “Brushing” Program
In the course handout, the Wilbargers described their program as “an advanced treatment program used to specifically treat Sensory Defensiveness. The program uses the consistent and frequent application of Deep Touch Pressure and Proprioception without noxious input such as scratching or tickling. Although research on this technique is limited, clinical experience over many years with a wide range of clinical populations and ages indicates that the it can be very beneficial in reducing or eliminating sensory defensiveness when applied consistently and used within the context of a comprehensive treatment program.”
Yes, but what is it???
In functional practice, the brushing program involves taking a specific brush, very similar to a surgeon’s nail scrubbing brush, and rubbing it firmly on the child’s skin in a particular manner. This is followed by deep pressure to the joints every 2 hours while the child is awake. According to the Wilbarger Protocol this is ideally done 8 to 10 times per day for several weeks. Brushing has been renamed by the Wilbargers as the “Therapressure Program.” However, I have also seen it documented in the past as “The Wilbarger Deep Pressure and Proprioceptive Technique” and “Wilbarger Brushing.” I will continue to use the term “brushing” for this blog for the sake of simplicity.
Is it “All or Nothing”?
You are probably asking, “What? Do this every 2 hours? That is a HUGE time commitment! I can barely get my child’s socks on in the morning. I don’t think I can add something to our routine every 2 hours!” You are absolutely right. Though this technique is very inexpensive, it does take a lot of time. So I asked Patricia Wilbarger herself: Is it OK to complete the technique less often? Her reply: If you aren’t going to complete the program exactly, don’t do it at all. Simply focus on the sensory input and forget about the brushing.
The Wilbargers list many do’s and don’ts:
DO only use the brushing program if you have been directly trained in the Wilbarger Therapressure Program or very closely trained and monitored by an OT who has received this training.
DO only use the specific brushes designed for the protocol.
DO follow the “every 90-120 minute” protocol strictly.
DO report any adverse reactions to your supervising OT.
DO NOT brush the stomach or groin area.
DO NOT complete brushing or joint compressions on areas with any injuries such as cuts, scrapes, swelling, bruises, etc.
DO NOT complete with infants under 2 months of age.
Patricia Wilbarger Brushing Protocol
My own do’s and don’ts:
I will add a few of my own precautions, as I have seen many parents completing brushing incorrectly and actually causing much more harm than good.
DO only use the brushing technique once properly trained by someone who has been to the course. I have seen many parents brush in the wrong direction, brush the wrong areas of the body, use too light of pressure, lift up and replace the brush with every stroke, etc. All are wrong! Again, completing this technique incorrectly can most definitely exacerbate the situation rather than help it.
DO NOT apply brushing once a “meltdown” has occurred. Brushing should only be used on the scheduled timeline. Providing brushing when a child is already in “flight-or-fight” mode can just cause the situation to escalate even more.
Does it work?
So, cut to the chase, does it work? Hmm…maybe? In reality, I see very few families that are able to make the commitment to brushing every 2 hours, utilizing the correct technique every time. In my own life, this would be impossible, so why would I ask this of another parent? In addition, the Wilbargers themselves report that there is limited research affirming the efficacy of this technique. Therefore, in my own practice, I do exactly what Patricia Wilbarger recommends: I focus on providing the other sensory input that is needed by the child to calm his sensory system. But wait! Are you still itching to try it? Come on over. I will be more than happy to teach you! Give my clinic a call. We have several TEAM OTs trained by the Wilbargers in the Therapressure Program.
Have you used brushing in the past with your kiddo? What did you think? I would love to hear feedback from parents who have been in the trenches with the brushing technique!
Do you have a question or comment for Melissa? Contact us to share your insights.
About the author:Melissa Foster, MS, ORT/L, is a veteran therapist with many years of experience in pediatrics.
Resources:
Therapeutic Brushing Techniques
Therapressure Program (Trademarked) for Treating Sensory Defensiveness – Training Course
What is Sensory Processing Disorder? Monday’s with Melissa Blog
What Is The Wilbarger Brushing Protocol?
The Wilbarger Deep Pressure and Proprioceptive Technique was developed by Patricia Wilbarger, Med, OTR, FAOTA. Based on the theory of Sensory Integration, the brushing technique uses a specific method of stimulation to help the brain organize sensory information.
Patricia Wilbarger Brushing Programming
Our skin is our largest sensory organ, followed closely by our muscles and skeleton, connected by our nervous system and governed by our brain. The sensory system feeds information from our environment, via our central nervous system, directly to our brain. The brain then organizes it, and sends it back through the nervous system for the purposes of understanding, adapting, learning and skill development. When our nervous system functions well, it allows a person to interact with their environment efficiently, developing necessary motor and language skills as well as appropriate social/emotional behavior. When our system is unable to organize the information appropriately, a variety of symptoms can be present: motor delays, tactile defensiveness, learning disorders, social or emotional difficulties, speech and language deficits and attention disorders.
Many children have atypical sensory processing. They have difficulties with too much (hypersensitive) or too little sensory (hyposensitive) inputs, including tactile inputs (touch) and proprioception inputs (deep pressure). This can be called the Goldilocks and The Three Bears Principle. Not too much, not too little, just the right amount of touch and proprioception is desired. The Wilbarger technique is used to help children widen their “just right” zone so they are not as hyper- or hyposensitive to touch and proprioception. You should notice gradual improvement with tactile and proprioception sensitivity and seeking behaviors when you consistently apply this technique.
Patricia Wilbarger Brushing Program
The Purpose and Benefits:
- Can improve ability to transition between activities (calming after emotional outburst, improving tolerance levels).
- Can help children who have a fear or discomfort of being touched (tactile defensiveness).
- Can increase self-regulation and self-calming.
- Can increase the ability of the nervous system to use information from the senses more effectively, i.e. speech and/or motor.
- Can improve attention and focus.
- Children generally like the procedure!
The Wilbarger Brushing Technique should be introduced and practiced with a caregiver by the child’s occupational therapist so it can be integrated into the their daily routine. The technique uses a surgical scrub brush just like the brush that surgeons use to scrub their hands and arms before surgery. This plastic brush is not rough and will not scratch. It provides just the right amount of pressure and sensations to the skin.